Medications known as glucagon-like peptide-1 agonists, or GLP-1s, have become very popular as weight loss agents. Taken in accordance with the instructions on the label and an appropriate diet and exercise regimen, GLP-1s are effective at lowering a person’s weight.
But what about obesity prevention? What is sometimes missing in current discussions on obesity in the media and elsewhere is the role of prevention. Ideally, a newly revamped Department of Health and Human Services could reshape the nation’s food and nutrition ecosystem in addition to prioritizing more physical activity. But caution is warranted, as previous administrations as well as the current Becerra-led HHS, have attempted to address these issues. And thus far they haven’t accomplished the desired results.
About 40% of adult Americans are obese. Rates of obesity have been steadily rising since 1980. The Harvard T.H. Chan School of Public Health reminds us that obesity increases the risk of developing conditions such as diabetes, heart disease, osteoarthritis and some cancers, to name just a few. In turn, these diseases reduce the life spans of those affected by them. Furthermore, obesity-related conditions cost several hundred billion dollars to treat every year.
If confirmed by the Senate as Secretary of HHS, Robert F. Kennedy Jr. wants to tackle high rates of diabetes and obesity through lifestyle modification, including dietary and other behavioral changes. Integral to his vision are plans to “fix” the food system.
A British Medical Journal article explains that despite some individuals being genetically predisposed to unhealthy weight gain, the majority of people can “modify the vectors of obesity” by incorporating healthier eating habits and more daily physical activity.
Improving food safety and eliminating additives have invariably been popular themes for Kennedy, who has said that removing “harmful chemicals” will be a major goal of his. This is an area where the Food and Drug Administration exercises oversight, as it regulates roughly four-fifths of the United States food supply. Not known to mince words, Kennedy said on X that he intends to fire every nutritional scientist at the FDA on day one as “all of them are corrupt.”
On the role of GLP-1s to reduce weight, Kennedy has been critical. “They’re counting on selling it to Americans because we’re so stupid and so addicted to drugs,” he said in an appearance with Fox News that he posted to Instagram last month. He specifically cited the popular medication Ozempic, approved by the FDA to treat type 2 diabetes and used off-label for weight loss, as “not going to Make America Healthy Again.” This casts doubt on whether the incoming Trump administration will support the recently announced proposal by Biden to cover weight loss drugs in Medicare and Medicaid.
But there might be a strawman fallacy in Kennedy’s position, as experts have stated that addressing flaws in the food system isn’t mutually exclusive with the use of weight-loss medications. Perhaps then a charitable interpretation of Kennedy’s view is that because GLP-1s don’t aim to prevent obesity, they can’t solve the problem, at least not on their own. This would align with the position taken by the World Health Organization. As STAT News reported, the WHO considers weight loss drugs an important tool, but not a solution to the problem of worldwide obesity. Rather, what needs to happen, according to WHO, is a transformation of “food systems and the environment, such that obesity can be prevented.”
Kennedy told National Public Radio that Trump expects him to show “measurable impacts on a diminishment of chronic disease within two years.” Presumably this would include obesity, which may be a tall order. Positive results as a consequence of behavioral change are possible, but usually only after long periods of time. Consider, for example, a recent finding that increased physical activity was associated with reduced all-cause mortality in more than two million individuals with an 11-year follow-up. Similarly, a meta analysis tabulating the results of more than 150 studies examining the impact of dietary changes had a median follow-up of almost five years.
Even one of the most successful public health campaigns in U.S. history, took many years to bear fruit. Over a period of decades, policymakers at the federal, state and local levels took a multifaceted approach to curb smoking. The 1964 U.S. Surgeon General’s Smoking and Health report was followed by legislation that added warning labels on packages of cigarettes. In 1971, ads were banned from television and later large increases in excise taxes were imposed, followed in the 1980s and 90s by prohibitions on smoking in public spaces.
With obesity prevention, the issue may be more difficult than Kennedy imagines, given the lengthy history of attempts to address it through federal government initiatives. The nutrition and physical activity problem in the U.S. has long been recognized. It’s one that administrations from Carter to Biden, have sought to address, but seemingly unsuccessfully.
Since the Carter administration, every five years, the Department of HHS and U.S. Department of Agriculture convene the Dietary Guidelines Advisory Committee to review existing evidence on diet and health to inform the next set of recommendations for Americans. The Dietary Guidelines not only counsel Americans on what to eat; they also set budgeting priorities for the hundreds of millions of dollars that the government invests in food programs, such as the Supplemental Nutrition Assistance Program, formerly known as Food Stamps. Notably, over time, the committee’s focus has shifted away from single nutrients or foods and toward overall dietary patterns. The 2025–2030 U.S. Dietary Guidelines developed under the Biden administration include a historic shift in favor of plant-based whole foods.
Former First Lady Michelle Obama led a program called “Let’s Move,” which was aimed at curbing childhood obesity. President Barack Obama had established a Task Force on Childhood Obesity in 2010, with the lofty goal of solving the problem of childhood obesity within a generation. He announced the First Lady’s role in leading a national public awareness effort to improve the health of children with dietary and exercise guidance. Obama stated that “to meet our goal, we must accelerate implementation of successful strategies that will prevent and combat obesity. Such strategies include updating child nutrition policies in a way that addresses the best available scientific information, ensuring access to healthy, affordable food in schools and communities, as well as increasing physical activity.”
And then, 12 years later, the Biden administration convened the second White House Conference on Hunger, Nutrition, and Health in 2022, 50 years after the first was held. The administration soon began implementing a new national strategy for “ending hunger and increasing healthy eating and physical activity so fewer Americans experience diet-related diseases.”
The Biden administration says it has made school meals healthier, strengthened nutrition standards in the Special Supplemental Nutrition Program for Women, Infants, and Children program and banned certain pesticides. The administration asserts it has invested in local food systems while pursuing policies that combat agricultural industry consolidation.
Also, the Secretary of HHS, Xavier Becerra, hosted its first-ever “Food is Medicine” summit in January 2024, featuring stakeholders examining the intersection between food and health. HHS aims to cultivate an understanding of the relationship between nutrition and health, facilitate easier access to healthy food, particularly in under-resourced communities, and educate the public on which nourishment is essential for better health.
It’s not known if Kennedy would build upon these actions. Though he suggests tearing things down at the FDA’s nutrition division, maybe that’s exaggerated rhetorical spin just to show he’s determined to shake things up. In terms of concrete steps to accomplish his objectives, we haven’t seen an actual plan except that Kennedy has indicated his intent to prohibit SNAP beneficiaries from using their benefits to purchase sugary beverages or ultra-processed foods. However, this ties into what the Biden administration has already been pursuing since 2021 as it seeks to increase benefits for buying fruits and vegetables and allow states to remove sugar-sweetened drinks from the list of foods covered by SNAP.
In brief, some of what Kennedy is saying is not new or radically different from what is ongoing policy or what has been done before. Nevertheless, after having coined the catchy MAHA acronym, it’s likely Kennedy will make federal government efforts to prevent obesity more visible than they’ve been in prior iterations.
